This morning Anthem sent agents the grandfathered plan change downgrade matrix for 2018.

This shows which plans are being cancelled and which, if any, grandfathered plans those affected can move to. If they wish to remain grandfathered.

Some plans have grandfathered options, some have no options. If there are no options to move to another grandfathered plan AND you live in an area where Anthem is no longer selling ACA plans, you will have to change to another insurance company for 2018. Remember Anthem is only selling ACA plans in areas 1, 7 & 10 in 2018.

Agents are ready to help you with your 2018 health insurance options. Call your agent, call me, heck, call trump if you want to 😉 Plans scheduled for discontinuation will end on 2/28/2018. Last date to enroll in a new ACA plan is January 31 however to start 2/1 enrollment needs to be completed by January 15th.

California subscribers may have received a letter early in December indicating that their grandfathered Anthem health insurance plan was being cancelled 2/28/18. Apparently some letters were sent in error and those plans are, in fact, not being cancelled.

Correction letters were supposedly sent out 12/8 to notify those subscribers of the error. So be on the lookout if you received a cancellation letter regarding your grandfathered Anthem health plan.

As of today, the only plan I know is being cancelled is the Clear Protection 5000. Some HIPAA plans may also be cancelled.

Anthem is not releasing any information to agents about which plans are being discontinued nor which clients are affected. Nice 🙄

If you have received a cancellation notice and not the subsequent "we goofed" letter, please comment on which plan you are on. Maybe we can figure out the super secret list of plans.

The California Department of Insurance and Insurance Commissioner Dave Jones announced this morning that the department is seeking to suspend or revoke Wells Fargo's insurance licenses.

Department
alleges Wells Fargo signed up 1,500 consumers for insurance without their
consent Department of Insurance seeking to suspend or revoke its licenses for
alleged improper insurance sales practices related to the company's online
insurance referral program, which resulted in insurance products being
purchased and paid for by consumers without their knowledge. Read the Dept of Insurance Accusation

This year’s largest corporate acquisition will combine one of the nation’s largest pharmacy benefits managers (PBMs) and pharmacy operators with one of its oldest health insurers, whose national business ranges from employer healthcare to government plans. This merger may signal a change in the delivery of certain healthcare services.

CVS plans to use its low-cost clinics to provide medical services to Aetna’s roughly 23 million medical members. In addition to health clinics and medical equipment, CVS could provide assistance with vision, hearing and nutrition.The merger still needs approval as similar mergers between Aetna & Humana as well as Anthem & Cigna were denied last year. However, in those cases both parties were health insurance carriers, not pharmacy benefit management.

Grandfathered plans are those health insurance plan purchased prior to 2010 and still in force.

To reduce the administrative burden of maintaining multiple products/contracts, we will be discontinuing about 200 grandfathered plans/contracts, many of which only have a few members. This change will impact around 14,000 members and some of these members may have other Anthem options to replace their plans.

As of today, the specific products and contracts are unknown. I was told we should expect more information by mid-December.

For those on grandfathered plans, be aware that Anthem is only selling individual health insurance (EPO) in areas 1, 7 and 10 (Santa Clara County, Stockton area and northern Counties). Those in other rating areas will need to change insurers and find new coverage (and move to ObamaCare).

When it comes to HealthNet individual & family health plans, things can get a little tricky.

HealthNet has offered their traditional PPO plan in selected areas of California for a few years now. This PPO is a broad-network plan. In areas where it is available, the network exceeds that or competitor Blue Shield. The new EnhancedCare PPO is a smaller network PPO plan introduced in certain regions for 2018.

In 2018, HealthNet has made some changes so I want to cover them here.

Traditional PPO (off exchange only)HealthNet's traditional individual & family PPO plan for 2018 will be available in the following regions:

According to Kaiser Health News, the California Department of Managed Health Care (DMHC) has fined Anthem 5 million dollars for failure to address member grievances.

According to DMHC, between 2013 and 2016, it (DMHC) identified 245 grievance-system violations by Anthem.

Rouillard cited one example in which Anthem denied a submitted claim for an extensive surgical procedure, even though it had issued prior approval for the operation. Twenty-two calls contesting the denial — placed by the patient, the patient’s spouse, the couple’s insurance broker and the medical provider — failed to resolve the complaint. It was not until the patient sought help from the managed-care agency, more than six months after the treatment, that Anthem paid the claim.Read the full article at KHN

I have been informed online instant quotes for 2018 ACA California health insurance plans will be live tonight beginning 9 PM PST. For both agents and consumers, this will be our first comprehensive look at plan choices and rates.

Take a spin to the link below and 'shop til you drop' for your complimentary quote. Think of it as "Black Tuesday" for California health insurance. Quoting both Marketplace (Covered CA) and off-exchange plans.

With the removal of the cost share reduction subsidies by the federal government, and the resultant additional silver premium changes to cover the CSR in 2018, some interesting results are found on Covered CA (and likely all marketplaces).

Quick Primer. CSR (cost share reduction) subsidy is the subsidy used to reduce the share of cost on a silver health plan. These are known as enhanced silver plans and the CSR helps reduce things like copays, deductible, out of pocket annual max and drug costs. CSR is available to adults wit incomes in between 138%-250% federal poverty level. These enhanced silver plans are expressed as Silver 73, Silver 87 and Silver 94. Which one you qualify for depends on income level.

Note: families with children under 19 years of age can qualify for enhanced silver in California. However, the children under 19 will not be entitled to enroll in the enhanced silver plan with their parents The income level for Medi-Cal (California Medicaid) is raised to 266…

Direct Primary Care, also known as 'concierge medicine', is gaining traction across the country. DPC is primary medical care without insurance or other third party payer,

Direct primary care is essentially becoming a member of a primary care doctor's practice. Monthly membership fees are reasonable and may include certain services at little or no additional cost.

DPC doctors normally feature transparent pricing for services they provide. Often services include telemedicine (Skype, e-mail, etc,,), longer and more thorough office visits and may even include house calls.

Coupling a DPC membership with a lower cost, high deductible health insurance plan can provide for comprehensive coverage and lower premium costs. This can also be used with a MedicaidPlus strategy (I will cover this in a future blog) to create even more premium savings.

While expansion of DPC providers continues, there are still areas where no DPC providers are nearby. For Santa Clara County residents…

On Thursday, in addition to issuing an executive order to make changes in health reform, the administration announced that the federal government would cease paying all CSRs immediately.

Cost Sharing subsidies are not the same as tax credit subsidies.

Tax credit subsidies, which can be advanced, are applied to the premium payment on a health insurance plan purchased through the marketplace.

Cost Share Reduction subsidies are available to help lower the costs of services under the health plan, CSR applies to things like deductible, co-pay, drug cost and out of pocket annual maximum. All CSRs are in the Silver metal tier and, depending on income level, can be at 73%, 87% or 94% reduction.

In California the CSR is available to people who have income between 138%-250% of the federal poverty level (see chart).

In response, health insurers have increased the premium rates for all indiviudal & family Silver tier plans to make up for the loss of funding.

Today, President Trump signed an executive order to make changes in the health insurance marketplace.

The Executive Order mainly addresses three areas and goes a ways towards the Rand Paul concepts.

1. Association Health Plans. Health plans sponsored by an association could be sold to groups who are members of the association. These plans would not have to meet ACA (Obamacare) essential benefits and coverage mandates. This could reduce premium costs.

2. Selling Across State Lines. Association health plans could be sold across state lines which, in theory, could reduce premium costs.

3. Short-Term Health Insurance. Currently these plans are only available for 90 days or less. This EO would restore short-term plans to a longer period (six or twelve months depending on state). Prior to the rule change under Obama HHS/CMS, short-term plans in California were limited to six months duration per enrollment.

I suspect there will be some fighting over this executive order. California…

Covered California, California's state health insurance marketplace, went live this afternoon to shop and compare plans for 2018.

California Healthline reports that Covered CA chose to raise rates an additional 12.4% (weighted average) on Silver plans. This action is due to uncertainty about the Trump Administration continuing to fund the cost-share reduction subsidy.

In August, Covered California announced that 2018 premiums would rise by 12.5 percent, on average, statewide. That ticked down slightly to 12.3 percent during regulatory review. But the exchange also warned that the additional increase, averaging 12.4 percent, would be added to the silver-tier plans if President Donald Trump failed to commit to continued funding for the so-called cost-sharing subsidies that help reduce some consumers’ out-of-pocket expenses. Those payouts total about $7 billion this year nationwide.California Healthline Article

Anthem Blue Cross (CA) has announced that they are releasing a new Medicare Supplement (Medigap) Plan for California residents. The plan will be available beginning January 1st, 2018.

'Innovative F' will offer benefits not covered by a Medicare Supplement base plan. These will include a hearing benefit (exam, fitting and allowance) and a vision benefit (exam, lens co-pay and allowances for frames and contact lenses).

Anthem states that the Innovative F will have a very competitive premium rate. Innovative F will include the Silver Sneakers fitness program and will be eligible for the Plan F 'new to Medicare' $20 per month first year discount.

Anthem has reached a settlement agreement related to the 2015 cyber attack.

Under the settlement, which was preliminarily approved by the court on August 25, 2017, Anthem does not admit any wrongdoing or acknowledge that any individuals were harmed as a result of the cyber attack.$15 million of the fund will be allocated to pay actual
out-of-pocket costs, up to a set amount, that settlement class members
claim they incurred due to the cyber attack.It will pay for two years of credit monitoring and identity
protection services for settlement class members who want them.It will allow settlement class members who already have
credit services to submit a claim to receive alternative compensation for
up to $36 instead of credit services.

Kurtzman Carson Consultants (KCC) will manage the settlement and is the best resource for questions.

Blue Shield of California is now offering a Medicare Supplement Discount of $25 per month for the first 12 months for those new to Medicare (Part B).

For California residents turning 65 and enrolling in Medicare, or those who are enrolling in Medicare Part B after 65 for the first time, this discount is available on Supplement Plans A, C, D & F (G will be coming out soon and will also offer this discount). This discount is not available on High F nor Plan N.

An additional $3 per month discount is available if you choose to pay your premiums using their EZPay automatic deduction.

Blue Shield currently offers year round birthday rule open enrollment for California residents.

Call or e-mail for a quote and discounted premium rate on your Medicare Supplement plan.

News sources are reporting that the last grasp Graham Cassidy bill will be voted on early next week. Ahead of the September 30th deadline (the last day the bill could pass with less than 60 Senate votes).

Certain provisions within this legislation would have a direct and potentially negative impact on Medi-Cal (California Medicaid).

Under the ACA (ObamaCare), California expanded Medi-Cal as allowed under the law. This expansion is, in large part, funded by the federal government and not the state government. Adults with incomes below 138% Federal Poverty Level and children under 19 with family incomes below 266% are eligible to enroll in MAGI Medi-Cal. The expansion did away with asset testing and eligibility is determined by income.

Simply put, under the proposed Graham Cassidy bill, the expansion of Medicaid (Medi-Cal in California) would be reversed and future federal funds that might be used by states would be provided in block grants. This reversal would essentially remove th…